“Well, maybe she gets up all the time because of all that breastfeeding.”
“If you let her cry, she will grow up to feel unloved and insecure.”
“If you always pick her up, you will spoil her and she will never be independent!”
“You have to feed on demand, around the clock, in order to breastfeed.”
“If you bed-share, be careful, the baby can suffocate!”
“If the baby sleeps in a crib away from you, she will feel abandoned.”
“Breastfeeding can be a cause of postpartum depression, you know.”
“Bottle-feeding is a way to separate moms from their babies, and you can get postpartum depression from being separated.”
"In order for the baby to feel secure, you must be available at all times, so she doesn’t cry.”
“Letting a baby cry is ok, even if she vomits.”
Do these contradictory things sound confusing? I personally heard every one of these things when I became a mom. It’s hard to describe how overwhelming it was to process all of this stuff, in real time, at the time I needed help sixteen years ago. Yes, a mother’s mental health influences the mental health of her baby. Depression in mothers affects their babies. Also, depression is fed by lack of sleep.
Today, in my counseling practice, I see new moms struggling with postpartum depression every week, women who are exhausted and feeling bad about themselves. They are new parents, learning so many new things, feeling sort of insecure, trying to develop a new identity as a parent.
I get a lot of infant sleep questions, and there really isn’t any professional training out there about this subject, so a lot of advice given out in practice is personal opinion. So, I decided to get more clear about this subject by reviewing the current infant sleep authors and hitting the research libraries to develop a balanced approach to infant sleep that serves the needs of both mother and baby.
Elizabeth Pantley’s No-Cry Sleep Solution
After reading a few of the books, I decided to start with a review of Elizabeth Pantley’s “The No-Cry Sleep Solution.” Well, I thought, as I read this book, so there IS a middle ground. Her method is a balance between the polarized cry-it-out camp and the attachment parenting nurse-to-sleep camp. Mrs. Pantley feels the emotional needs of both mother and baby are met with a solution balanced between the stress of all night, no-sleep parenting and the stress of cry-a-thons.
Balancing Parents’ Needs with Babies Needs
On one hand, Mr. & Mrs. Pantley believe the current experts who support cry-it-out sleep methods are ignoring the emotional needs of babies. They wish to support parents in sensitive parenting. They compare crying-it-out to ignoring, day after day, a child’s request to play ball, or missing a child’s musicals at school. Sure, the child gets used to it, but the need for sensitive and responsive parenting has been brushed off at an early age, and this pattern of insensitivity is a pattern of parenting to which the Pantleys do not subscribe.
On the other hand, Mrs. Pantley, the mother of four children, says she could not continue with the emotional and physical fatigue of all-night (and day) attachment parenting. Mrs. Pantley’s personal experience with her four children showed her that some children easily sleep through the night and others emotional temperament did not allow that.
Understanding age-appropriate sleep behaviors
Mrs. Pantley emphasizes that it is natural for a baby to want to suckle to sleep, and in different cultures, practicing attachment parenting is not as difficult as it might be in our modern culture, where mothers are often the only caregiver available all day long. In our culture, being an isolated caregiver, coping with the demands of multiple children, working outside the home, and being a caregiver to an older relative place are just some of the things modern moms are juggling.
Mrs. Pantley includes information about appropriate expectations about infant sleep. She notes that a baby’s sleep consolidation is dependent on biological considerations, as the infant brain is not mature at birth. Thus, the sleep consolidation schedule does not mature until about the fortieth week of life. She says that it is normal for babies to awaken about three times per night until around the fortieth week.
From multiple night wakings to a full night’s sleep in 60 days
Mrs. Pantley developed a no-cry method for her baby that took him from multiple night wakings to a full night’s sleep in sixty days. She tested her method with sixty real-life mothers who were exhausted from continuous nighttime parenting and had a 92% success rate in sixty days.
The first step is to assess your home for infant sleep safety. In prevention of SIDS, she advocates putting the baby on her back to sleep, and if you choose to co-sleep, to take the necessary precautions to safely do so. The next step is realistically assessing your lifestyle (breastfeeding, bottle-feeding, sleep-sharing, not sleep-sharing) and your current night-time patterns. She provides forms to help you with this assessment.
In addition, she asks the mom to consider her own emotional readiness for changing their sleep patterns. In other words, examine your own feelings about separating from your baby at night. This could be a part of your assessment.
When you have done the initial lifestyle assessment, use this information to , begin to make some changes that are right for you and your family. In general, the gentle techniques she advocates are understanding why your baby is waking, introducing new routines and associations for sleep and then gradually change the patterns. Mrs. Pantley also advocates for a nap schedule and early bedtimes to increase sleep and avoid a sleep deficit. She urges us to be cognizant that it is our modern hectic life-style and lack of social support that is driving our need to teach a baby to sleep. However, sleep is necessary for a mom to function.
An overview of some of her methods
To manage breastfeeding, if it is age-appropriate, respond less quickly with the breast to your baby’s stirring, to see if she is really needing to nurse or is really awakening or is just stirring
Don’t allow the baby to fall asleep at the breast every single time, instead allow her to nurse to sleepiness, then put her down to fall asleep, so she will have other associations for sleep besides nursing
Incorporate the Pantley Gentle Removal Plan into your nursing practice. Know that babies have a need to suck, allow baby to fall asleep at the breast, pacifier, or bottle, then slowly detach the baby and gently hold her lips closed or press her chin. Repeat patiently until the baby’s sleep behavior slowly changes
If baby is used to falling completely asleep on you, slowly shift that routine to letting the baby almost fall asleep on you, and then move her to her sleep area to completely fall asleep. This would need to be done multiple times.
Create good associations around sleep area, read a favorite book to your child while she is in her sleep area
Create and use the same sleep cues every time, such as saying “Time for night-night,”, use the same bedtime music
If bedtime is too late, modify to an earlier bedtime in increments of 15 minutes every evening.
Watch for signs of sleepiness and create a nap schedule around this
To lengthen her nap, when baby awakes, use the sleep cues to help her fall back asleep, such as nursing, pacifier, bottle. This should help lengthen the nap after about a week.
What I take away from this method
If you are a mom who is not having any trouble with your baby’s sleep, and things are going well, don’t bother reading any of these books (unless you are helping a relative or a friend out!).
As a therapist who sees depressed moms, I can definitely incorporate some of Mrs. Pantley’s methods into my work. Her methods are a nice balance between baby’s needs and mom’s needs.
I think that a depressed mother may have some trouble focusing and sorting through her feelings and doing the written lifestyle assessment by herself. But it could be done with help from a trusted friend, a relative, a postpartum doula, her partner (if s/he is on board), her pediatrician, or her therapist. Also, an overtired or depressed mom may not be capable of sticking to the methods, gentle though they are, or of taking the time needed for the behavioral adjustment. So, she may need practical outside help, such as a postpartum doula, to get through the first few weeks.
I think it is good practical advice for moms who practice attachment parenting and breastfeeding to be aware of the use of sleep associations and to sometimes allow the baby to almost fall asleep at the breast and to also sometimes put her down gently before she completely falls asleep. This sets up the scenario for falling and staying sleeping without mommy, so mommy can get some rest. I really like the Pantley Gentle Removal Plan; she gives a mom a gentle how-to here. Depression is fed by lack of sleep, so it is a good thing to put Mom’s needs into the mom-baby equation. Be kind to Mom, help her practice self-care.
I think she is kind to both parents and babies and uses research and experience to support her methods. No mention of locking doors or letting the baby vomit. Good show. All in all, I am glad I met Mrs. Pantley; she seems kind and balanced. Next week I am going to discuss Dr. Harvey Karp’s methods. At the end of the series, I plan to put together a consolidated overview of the current thinking on Infant Sleep. Thanks for going through this process with me!
Please let me know what you think!
Babson, K. A. et al (2010). A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension. Journal of Behavior Therapy and Experimental Psychiatry, 2010;41(3):297-303). Retrieved March 5, 2011 from Academic Search Premier Databases.
Pantley, E. (2002). The no-cry sleep solution: Gentle ways to help your baby sleep through the night. New York: McGraw-Hill.
Sohr-Preston, S.L. & Scaramella, S. (2006). Implications of timing maternal depressive symptoms for early cognitive and language development. Clinical Child and Family Psychology Review, 2006,;9(1), 66-83. Retrieved February 15, 2011 from Academic Search Premier Databases.